Memory and Identity

Memory is identity. I have believed this since… oh, since I can remember. You are what you have done; what you have done is in your memory; what you remember defines who you are; when you forget your life, you cease to be, even before death. Julian Barnes

Identity is deeply tied to memory. As we go through life we collect memories. These form the foundation for future experiences, and further collection of new memories. Think about building blocks, each tier supports another. Without a foundation there can be no further development. So, what happens when building blocks are stripped from the wall? It all depends on how many. If someone loses too much memory they can no longer function,they do indeed lose their identity. But what about losing some, but not all? Well that is a grey area. One can argue it depends on what the memories are.

Memories tend to fall into distinct categories; people, places, events, thoughts and feelings. As we experience life, and the events that make up each day our brain somehow stores these experiences. Much is discarded, usually the mundane. What tends to stay are the moments that are out of the ordinary. Moments where life is wonderful, when love flows, or on the flip side, when fear races in us, or sadness brings us low. This is how we develop. It also can help us change.

Memory steers our behaviors, as it is a tool our brain uses to learn. If we remember being bit by a dog, chances are we will avoid dogs. The brain remembers the incident and alters our behavior in an attempt to avoid another unpleasant experience.

So, when memory loss is dismissed as an acceptable side effect of ECT, I counter with the above argument. The problem with ECT is it doesn’t just select one type of memory. Nor does it just take them from a certain time frame. There is no way to know for sure what will be lost. It is in that reality that my fear lies. It is the unknown variable. The one that not a doctor on the planet can explain. No one knows exactly why some memories are lost, and no one can tell you which ones they will be. My anger lies in the fact that it is not explained before the procedure is done. As a patient, I deserved to know this. It was my decision to make, but it needed to be informed and educated. The issue with informed consent and ECT is a grave one. Each hospital and treatment center has their own way to explain the procedure, and gain consent. It is possible that the one I was in, did not really focus on the cognitive issues. I remember almost none of the sessions in which consent was explained. I do recall some of it. The rest I know from talking to my partner, since they involved her in every step of the process (as they should have). I’m not the only one that was taken by surprise by the extent of the memories missing. She too deals with it everyday.

I can’t understand why some people don’t lose much, and others lose a lot from ECT. I don’t think any formal studies have been done to attempt to explain it.There is definite correlation between bilateral treatments and memory loss, and the larger the number of treatments, the greater the chance of losses. Those relationships are known, but it still doesn’t explain how ECT erases memories.

When I think of all the patients lined up waiting their turn, and think of all the patients I saw during my various inpatient visits that were undergoing treatment, I can only think of the memories lost. How many building blocks removed from the timeline of life. How many identities forever altered by one minute seizures, three times a week.

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